Common Conditions

AAP Recommendations on Circumcision

Among the many considerations new parents must make for their newborn sons, one is circumcision.

Simply put, circumcision is the removal of foreskin from the penis and is done for a variety of reasons. For some families, it’s part of their culture or religion. Others believe that the procedure offers health benefits.

But circumcision is by no means universal. In 2006, the World Health Organization (WHO) estimated that about 30% of men worldwide – about 665 million men – are circumcised. The practice is widespread in Africa and the Middle East, fairly common in North America, and not as common in Europe and Asia. In the United States, it’s estimated that that between 20% and 80% of males are circumcised, usually when they are newborns.

Some parents choose not to circumcise, feeling that the procedure isn’t medically necessary and isn’t fair to perform on a child who can’t provide informed consent.

American Academy of Pediatrics (AAP) Revises Policy on Circumcision

On August 27, 2012, the American Academy of Pediatrics (AAP) revised its 1999 policy on circumcision, stating that “the health benefits of newborn male circumcision outweigh the risks” and that parents who choose circumcision for their sons should have access to the procedure. The AAP did not go as far as to recommend circumcision, but did make recommendations about it, based on a comprehensive review of medical literature conducted by a task force of representatives from the AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the U.S. Centers for Disease Control and Prevention.

Today, we’ll take a closer look at the revised policy.

Benefits of Circumcision

In reviewing the literature, the AAP task force found that circumcision has the following benefits:

Protection from STIs, including HIV. Circumcision is associated with a lower prevalence of infections from human papillomavirus (HPV), herpes simplex virus 2 (HSV-2), and bacterial vaginosis (BV) in female partners. It is also believed to reduce the risk of acquiring HIV, the virus that causes AIDS. How does circumcision protect against these infections? An intact foreskin is more likely to develop microtears and abrasions – areas through which pathogens can enter the body. It is also an area where “trapped” pathogens can survive and grow. A circumcised penis, on the other hand, has no foreskin and less area for pathogens to enter the body, grow, and spread.

Reduced risk of urinary tract infections (UTIs). UTIs are infections that affect the kidneys, ureters, bladder, or urethra. They are quite common in males up to age 1. The AAP reports that data consistently show an association between circumcision and reduced likelihood of UTIs. This may be because the foreskin on uncircumcised males provides an environment for bacteria to grow.

Risks of Circumcision

Complications of circumcision are not common. However, the AAP reports that the following problems could occur with the circumcision of newborns:

Acute Complications

Bleeding

Infection

Inflammation

Imperfect amount of tissue removed

Penile injury

Late Complications

Adhesions

Skin bridges

Meatal stenosis (a narrowing of the opening of the urethra)

Phimosis (an inability to pull back the foreskin)

Epithelial inclusion cysts

Major complications, such as glans or penile amputation and transmission of herpes simplex virus, are considered rare.

Boys circumcised between the ages of 1 and 10 are more likely to have complications than newborns, but these complications are still rare in the United States. In this age group, general anesthesia is necessary, which adds risk.

The AAP stresses that newborns should undergo circumcision only if they are stable and healthy. Only trained clinicians should perform the procedure, which should be done in a sterile environment with proper pain management.

Education on Circumcision

The AAP policy states that parents should learn about circumcision early – even before conception, if possible – so that they can take their time making their decision. They should receive factual, accurate, non-biased information about the procedure, its benefits, and its risks. And they should be instructed in the care of their son’s penis, whether he is circumcised or not.

The AAP makes educational recommendations for healthcare providers as well. Clinicians performing circumcisions should be properly trained in the procedure and in analgesic techniques during post-graduate training programs. The AAP also calls for training materials that will help practitioners discuss circumcision with parents.

Parental Choice About Circumcision

Ultimately, the decision to circumcise is up to the parents. The AAP recommendations state, “Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”